Provider Demographics
NPI:1790016954
Name:CAPITAL RESOURCE AGENCY, INC
Entity Type:Organization
Organization Name:CAPITAL RESOURCE AGENCY, INC
Other - Org Name:COMFORTS OF HOME CASEMANGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:304-720-7313
Mailing Address - Street 1:411 D ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-3107
Mailing Address - Country:US
Mailing Address - Phone:304-720-7315
Mailing Address - Fax:304-720-7316
Practice Address - Street 1:411 D ST
Practice Address - Street 2:SUITE 4
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-3107
Practice Address - Country:US
Practice Address - Phone:304-720-7315
Practice Address - Fax:304-720-7316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22301220251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810010882Medicaid